Parents unhappy with my specialty choice. Wat do?

[DermViser]

I don't really have a dog in this race, I'm genuinely curious

I didn't say you had a dog in this race. We're talking about the OP and his specific circumstances.

---

Members don't see this ad.

 

[DermViser]

I mean to go for a subspecialist like GI. Same question. Do you think it's reasonable to do GI over Derm/ophtho/radonc if you can do both?

I would say if you were absolutely assured of GI then it might be worth it. To have to do ANOTHER 3 years of hustling and bustling to stand out in your class, publications, schmoozing, maybe even a Chief year, etc. to get to GI or Cards or Heme/Onc is the issue (when you already did that for med school). Eventually it will be come a job just like every other specialty and you will prize certain aspects of the specialty that Derm/Ophtho/RadOnc inherently have that GI does not long after GME is over.

 

[Dral]

During my intern year, I think I felt most sorry for the GI fellows. They were so busy and just always looked unhappy and too stressed.

Wait, I actually take that back...I felt most sorry for me on my ICU month. GOD I hated that place. But that's why I'm a dermatologist and not an intensivist.

 

[DermViser]

During my intern year, I think I felt most sorry for the GI fellows. They were so busy and just always looked unhappy and too stressed.

Wait, I actually take that back...I felt most sorry for me on my ICU month. GOD I hated that place. But that's why I'm a dermatologist and not an intensivist.

I think the only people I saw more stressed than the GI fellows, were the Cards fellows and maybe the Pulm/Critical Care fellows. And yes, I never want to ever see an ICU again (outside of a mandatory consult), unless I have to for a family member.

 

[DermViser]

Trying not to sound naive here, but does it really become absolutely just a job? Just like being a lawyer, working at a store? In that case, why not just do something with a good lifestyle because whatever intention we have going into something we enjoy doing is probably short sighted, right?

Every specialty becomes boring or repetitive if you do it often enough. The initial excitement, etc. either fades away completely or wears you out. Hence why other characteristics are important: Is it action oriented? Can you easily appreciate an improvement (sorry, but I can't appreciate your HCTZ working bc your vessels are inside you and I can't see it change), is your input appreciated by others on the healthcare team, etc.

 

[Cytarabine]

Every specialty becomes boring or repetitive if you do it often enough. The initial excitement, etc. either fades away completely or wears you out. Hence why other characteristics are important: Is it action oriented? Can you easily appreciate an improvement (sorry, but I can't appreciate your HCTZ working bc your vessels are inside you and I can't see it change), is your input appreciated by others on the healthcare team, etc.

Along that same line, since most of what you mentioned is derm-oriented, do you enjoy developing relationships with patients, having difficult discussions with patients, motivating behavior change, working within the family dynamic, etc. Things to think about beyond interest in specific pathology

 

[touchpause13]

Being negative does not= depressed. I just hate most people. Probably end up in pathology or something.

How are you fittin to go into psych if you hate most people? Talking to people is a key part of the job.

And just your overall outlook on life seems... depressing? At minimum existential. Are you french? Lol

 

[EMDO2018]

How are you fittin to go into psych if you hate most people? Talking to people is a key part of the job.

And just your overall outlook on life seems... depressing? At minimum existential. Are you french? Lol

My overall outlook on life is real. And the reality of life is depressing, most people are dumb, racist, everything from religion, to education (especially higher education), and so called service careers exist for the sole purpose of making money. People are greedy, selfish, primitive creatures.

 

[DermViser]

My overall outlook on life is real. And the reality of life is depressing, most people are dumb, racist, everything from religion, to education (especially higher education), and so called service careers exist for the sole purpose of making money. People are greedy, selfish, primitive creatures.

Pathology it is!

 

[DermViser]

Along that same line, since most of what you mentioned is derm-oriented, do you enjoy developing relationships with patients, having difficult discussions with patients, motivating behavior change, working within the family dynamic, etc. Things to think about beyond interest in specific pathology

Do you actually the think the current practice environment as it is now allows that?

 

[Cytarabine]

Do you actually the think the current practice environment as it is now allows that?

Which part of it? Geri, peds, fm, hospice and palliative med, heme onc have elements of those

 

[D4C]

My overall outlook on life is real. And the reality of life is depressing, most people are dumb, racist, everything from religion, to education (especially higher education), and so called service careers exist for the sole purpose of making money. People are greedy, selfish, primitive creatures.

I wouldn't want you as my physician as you are now. Find some joy in something before you turn into....

 

[jdh71]

I'm better at wards than my categorical cointerns. Because that's all I've done for 80 hours a week for the past 3 months. Whereas every rotation I've got to deal with a categorical intern who's been chilling out somewhere on allergy or whathaveyou. See, what you need is not people who know medicine. You need people to write notes, check labs, follow up rec's of specialists, checking on patients and collecting information for clinicians.

And what medical students need to know....is that's basically what being a general internist is about.

Punting...... All day long in medicine. It's all we do is punt.

Damn right I'm running my mouth. Deal with it.

Well yeah. You are mad. It's cute.

What is there to deal with? One more ass hurt intern upset by how hard residency is? Go tell people who are going to care. Like your mom. You'll get no sympathy from me or anyone else.

If you need some cream for your hurt ass ask one of colleagues who has a DEA to write one for you. Apply three times per day.

 

[general admission]

Top lel @ this thread

 

[jdh71]

I find that very hard to believe at a university medicine program that is directly connected to a medical school.

It's the truth. Not a single pre-lim. You all were not needed.

I remember when I interviewed at USC they had ONE prelim spot. Which I think they have now gotten rid off. With an intern class of 52. I promise IM doesn't "need" you guys.

 

[jdh71]

Trying not to sound naive here, but does it really become absolutely just a job? Just like being a lawyer, working at a store? In that case, why not just do something with a good lifestyle because whatever intention we have going into something we enjoy doing is probably short sighted, right?

I don't don't think so. I just got through tucking in a sepsic shock who came out of the OR following a prefer viscous. The guy was dying, would be dead by now, and is currently alive because I intervened. That's pretty ****ing cool man. And it sure gives me some purpose. More than sending someone home with some cream for a rash. I don't have a big issue with dermatologists. Medicine needs them. Every rash basically looks the same to me. Thank God someone does that stuff. I don't dislike anyone else doing any other specialty. I do what I do because it's what I think is cool. I'll do it until I don't think it's cool any longer. I don't mind the hospital. I didn't mind the longer hours most days. You gotta do what's right for you. Go with your gut if you don't want "just a job".

 

[notbobtrustme]

psych = ssri dartboard

there i said it.

 

[Nasrudin]

Well yeah. You are mad. It's cute.

What is there to deal with? One more ass hurt intern upset by how hard residency is? Go tell people who are going to care. Like your mom. You'll get no sympathy from me or anyone else.

If you need some cream for your hurt ass ask one of colleagues who has a DEA to write one for you. Apply three times per day.

I don't want your sympathy. I just want to hear myself describe truthfully what being a medicine intern is like. And I'm not even talking to you. But the general medical student body. Who get more bull**** spun at them than is possible to sort through about what primary care fields are actually like.

It's no longer possible to be credible MD generalist. There's too much to know.

If anything this has made me more confident in physician education vis a vis NP training. You simply have to narrow the field of view to be credible expert worthy of consultation.

General medicine is a meeting house for consultants.

And I'm doing just fine serving the customers. 10 at a time for whatever they have mind. Naturally my bum is quite sore.

 

[Raryn]

My God, this thread is ****ing ridiculous. It should have ended after the first few posts that told the OP to man up and just deal with his parents as best he could and it turned into yet another thread of Dermviser bashing IM.

Look, I'm at a fairly rigorous IM program. We have our caps set at the maximum allowed by the ACGME, 20 patients per team, 10 per intern and basically cap every call day. We don't come close to breaking work hours. Neither did the residents where I went to medical school, which was a large academic medical center.

At the beginning of the year when it is everyone's first month in their new role as intern/senior, do we work long hours? Of course. We're busy. We probably average 70-75 hours during wards in July-August. But once fall rolls around, people are becoming a fair bit more efficient. As the year progresses (i.e. for the majority of it), the entire team gets to the point where working 55-65 hours a week on wards is the rule rather than the exception. Depending on the call schedule there may be the rare week you still break 70, but to claim that all IM residents work 80++ every week is to just be ignorant. (and yes, NYC may be an exception to this generalization, because those hospitals are notoriously bad). ICU is a different animal, but that's only one month a year.

And you know who becomes the most efficient as the year goes on? The categorical residents. Many of the interns who are going into other specialties still lag behind, because they don't give a damn. And then they wonder why they hated it.

My last month of intern year, all the prelims had electives/easy rotations that would allow them to take the time off they needed to move and there were only categoricals on all the ward teams. At that point? 55 hours a week. And it would have been less except we spent a good portion of the day listening to music and screwing around with each other. That is what I went into medicine for.

 

[Raryn]

Finally a perk. Where do I sign up for these massive orgies in res?

Not that kind of screwing around. While I love my co-residents dearly... I don't love any of them quite that dearly.

 

[RJGOP]

Thanks for the info. What would you advise someone in our shoes (OP and myself) who let's just say can get into most fields with our scores but looking at IM. Would you advise against that for any reason?

Are you interested in subspecializing in IM? If so, I believe there are integrated programs, like for surgery, for GI and Cards, etc.

 

[jdh71]

Are you interested in subspecializing in IM? If so, I believe there are integrated programs, like for surgery, for GI and Cards, etc.

Nothing integrated, unless you are referring to physician scientist fast tracking. You have skin in that game though.

There is no real quick way to GI and cards.

 

[fancymylotus]

Well yeah. You are mad. It's cute.

What is there to deal with? One more ass hurt intern upset by how hard residency is? Go tell people who are going to care. Like your mom. You'll get no sympathy from me or anyone else.

If you need some cream for your hurt ass ask one of colleagues who has a DEA to write one for you. Apply three times per day.

god I love you

 

[Raryn]

Nothing integrated, unless you are referring to physician scientist fast tracking. You have skin in that game though.

There is no real quick way to GI and cards.

And to keep in mind, while the "fast tracks" are guaranteed fellowships, they are actually longer than doing it the traditional way. A typical "fast track" is 2 years general IM, 2 years cardiology/whatever, and 3 years of research leading to a total of 7 years (as opposed to 5-6 the normal way).

 

[greg1184]

The concept of a "real doctor" is silly. Everyone's trained to handle their own turf. Interspecialty bickering is going to be the downfall of physicians

It is not "going to be", it will be the downfall of physicians. I mentioned a few times in threads that medicine by its nature is a very schadenfreude environment. There are a lot of bitter doctors talking about how specialty X should be making less money, specialty Y are not real doctors, I can do anything that specialty Z does.

For example, I read an article talking about the negative perception of physicians by laypeople, yet the same article perpetuates those exact negative perceptions by taking potshots at colleagues of other specialties (in that case ophthamology and radiology). The medical profession needs to take a good look in the mirror and figure out how we can be more collegial to each other in the name of patient care. The culture of medicine is very difficult to change. We are supposed to be colleagues, aren't we? Together we stand, divided we fall.

 

[Cytarabine]

It is not "going to be", it will be the downfall of physicians.

Err, what's the difference? Lol

 

[jdh71]

And to keep in mind, while the "fast tracks" are guaranteed fellowships, they are actually longer than doing it the traditional way. A typical "fast track" is 2 years general IM, 2 years cardiology/whatever, and 3 years of research leading to a total of 7 years (as opposed to 5-6 the normal way).

exactly that three years of research is the skin in the game - do that or pay back

 

[jdh71]

Thank you for your contribution. This thread has made me seriously clinically depressed.

Why? You were looking for half a week and half a mil? And on the way there 40 hours training weeks without nights or weekends?

 

[SouthernSurgeon]

I want to do GI. I already applied. This thread kinda made me feel like I should have done something else lol

Don't listen to a dermatologist and a psychiatrist's opinions about what you want to do with your life then.

 

[jdh71]

I don't want your sympathy. I just want to hear myself describe truthfully what being a medicine intern is like. And I'm not even talking to you. But the general medical student body. Who get more bull**** spun at them than is possible to sort through about what primary care fields are actually like.

It's no longer possible to be credible MD generalist. There's too much to know.

If anything this has made me more confident in physician education vis a vis NP training. You simply have to narrow the field of view to be credible expert worthy of consultation.

General medicine is a meeting house for consultants.

And I'm doing just fine serving the customers. 10 at a time for whatever they have mind. Naturally my bum is quite sore.

There is a lot to know and it is harder to be generalist than a specialist, but at the end of that day someone needs to hold all the pieces together because the specialists are not going to, and patients will suffer. Don't let your small part in the big machines skew your perspective. General medicine is a calling - "God's work," if you will. I personally enjoy being the generalist at the extreme end of the physiology. I'm good at it too. Teach me how to write dialysis orders and I'd rarely consult anyone that wasn't going to show up with a knife in their hands. When all the rest of these other physicians show up in my unit or page me with panic in their faces or eyes, I calmly step up and say, "Don't worry bro, I got this . . . go back to, um, whatever it was that you were doing. Consider yourself responsibly relieved of your responsibility here because I know you have more important things to do." Look. Everyone plays a role, and everyone plays an important role, some of us simply take on more responsibility because the rest of you need to play your roles and let's be honest, some of you shouldn't be managing patients outside of your schtick anyway, because medicine is very nuanced. I need to move away from the "real doctor" phrase because it gets misunderstood, and mischaracterized. Every. Single. Time. Hurt feels abound when none is intended, though there does need to be a way to recognize the docs doing all the heavy living, getting all the disrespect possible, and still doing it anyway because its the right thing to do.

Sorry you haven't enjoyed your time on wards. I didn't enjoy every single day either, but I still look back at my time as an intern positively. When you focus on the negative that will be all you'll see. It's a common denominator of the human experience. Focus on the positive. Be good, think good, and you'll feel good. Plus time is on your side. They can only hurt you so long.

 

[Winged Scapula]

No. We don't need the help. You guys need the months.

If anything, at least for surgery, off service rotators make MORE work for us. I still shudder at the memory of the resident who are only held pressure for 10 minutes after I removed an IABP instead of the prescribed one hour.

 

[jdh71]

If anything, at least for surgery, off service rotators make MORE work for us. I still shudder at the memory of the resident who are only held pressure for 10 minutes after I removed an IABP instead of the prescribed one hour.

Exactly. I think its often not easy to depersonalize oneself and the experience in order to see the bigger picture.

And maybe all the more reason to get rid of just straight pre-lim positions, especially in surgery UNLESS the prelim is a surgical intern for a surgical sub-specialty like ortho, ENT, or urology.

 

[jdh71]

Well it sounds nice. It wasn't exactly what I was looking for. I was looking for a field that I enjoyed doing clinically + good reimbursement + hours that would let me enjoy some hobbies. I never really considered derm/ophtho/radonc seriously before now. I was thinking maybe I'm naive for picking a specialty that I enjoy doing because at the end of the day, working 40 hours a week and making good money doing something I don't like might make me happier than working 60 hours doing something I do like? That's the impression that I'm getting from this thread.

I think it's highly doubtful that doing something you don't like as much will make you "happier". Though a GI attending isn't going to be spending 60 hours a week working most weeks. You'll have some clinic days (or half days) and you'll spend most of your time scoping M-F. The weeks you cover call *could* be longer but that only of there is business and most scopes can wait and don't need to be done "right now, middle of the night" but there will be those.

 

[mercaptovizadeh]

Internal medicine and general surgery are the two pillars of the thing we call Medicine. All this ****ting on IM is unwarranted. The practice of IM can range from pan-consulting and pan-referring (bad in my opinion) to consulting and referring to subspecialists only when you need a procedure done (something that is becoming harder and harder to do). If you've worked for any amount of time with subspecialists, you will see that their perspective often becomes very narrow indeed because they prioritize their organ system of interest above others. There's a need for someone to put all the pieces together. To give you an example, I recall back in medical school an ICU patient with O157:H7 TTP-HUS and bowel perforation s/p repair with peritonitis and sepsis. Heme/onc wanted to scale back on the antibiotics because they were making the TTP - and multi-system organ failure - worse. ID wanted to escalate the antibiotics because of the sepsis. The generalist (the intensivist in this case) had to make the management decisions. I don't know how the case turned out, but these kinds of decisions are not trivial and they may make the difference between the patient living or dying.

 

[general admission]

The rents would also be more than happy to see me in General Surgery. To them (and hell, in the public view), being a "surgeon" is prestigious in and of itself.

But I was just not happy on my actual surgery rotation. Friends commented on it. Family commented on it. I became withdrawn and frequently lashed out at those I cared about. Lost weight, lost sleep. I broke down a couple of times. Being constantly made fun of, insulted, disregarded, flat-out ditched, not knowing basic things like where the ORs were, how the day worked etc (despite making an immediate, polite effort to ask those types of questions) was ridiculously frustrating. It's inexcusable that they didn't take the time to even teach someone as ridiculously polite and green as I was such basic things. More than a few people were absolute ****ing asses for no reason. Maybe I have an ego that is too fragile; I like to think I have thick skin. Enough was enough and I dreaded coming in everyday.

Whatever the case, it's seriously inexcusable, child-like behavior. I'm trying to separate my bad experience from the field, but I can't help it. I gained a tremendous amount of respect for general surgeons - they're the most versatile physicians in the hospital - and I also enjoyed operating itself. The experience itself turned me off of the field period.

 

[Dral]

I don't don't think so. I just got through tucking in a sepsic shock who came out of the OR following a prefer viscous. The guy was dying, would be dead by now, and is currently alive because I intervened. That's pretty ******* cool man. And it sure gives me some purpose. More than sending someone home with some cream for a rash. I don't have a big issue with dermatologists. Medicine needs them. Every rash basically looks the same to me. Thank God someone does that stuff. I don't dislike anyone else doing any other specialty. I do what I do because it's what I think is cool. I'll do it until I don't think it's cool any longer. I don't mind the hospital. I didn't mind the longer hours most days. You gotta do what's right for you. Go with your gut if you don't want "just a job".

Yep. Not too long ago I was called on a consult for a rash on this 38 yo's body. She had it for about a month...really itchy. Within 30 seconds I was telling the consultant to get a lipid panel. They looked at me all confused. I said "just please do it".

Eruptive Xanthomas

I think her TGs were over 1400...could have very well saved her life...or least a bunch of morbidity.

 

[DermViser]

Don't listen to a dermatologist and a psychiatrist's opinions about what you want to do with your life then.

He was deciding among ENT or Ophtho, before finally deciding on IM (with the hopes to do GI). Which he now isn't sure he made the right decision.

 

[DermViser]

My God, this thread is ****ing ridiculous. It should have ended after the first few posts that told the OP to man up and just deal with his parents as best he could and it turned into yet another thread of Dermviser bashing IM.

The discussion started with regards to the accurate number of hours in IM residency (which is what I was arguing that it's close to 80 and jdh71 says is closer to 60), with whether FREIDA is indeed accurate (it isn't), and finally to whether IM residency sucks, which was mainly between Nasrudin and jdh71. I didn't start that, to be fair.

 

[DermViser]

Well it sounds nice. It wasn't exactly what I was looking for. I was looking for a field that I enjoyed doing clinically + good reimbursement + hours that would let me enjoy some hobbies. I never really considered derm/ophtho/radonc seriously before now. I was thinking maybe I'm naive for picking a specialty that I enjoy doing because at the end of the day, working 40 hours a week and making good money doing something I don't like might make me happier than working 60 hours doing something I do like? That's the impression that I'm getting from this thread.

Well did you rotate in ENT and Ophtho and did you enjoy it?

 

[Danbo1957]

General medicine is a calling - "God's work," if you will. I personally enjoy being the generalist at the extreme end of the physiology. I'm good at it too.

I'm so proud of you, doctor. Really. I remember when you were just a douchesnozzle with so much to learn. You're there, man. And don't shy away from leadership positions-- take that Chief of Department when it's offered.

 

[DermViser]

I'm so proud of you, doctor. Really. I remember when you were just a douchesnozzle with so much to learn. You're there, man. And don't shy away from leadership positions-- take that Chief of Department when it's offered.

Were?

 

[Danbo1957]

Careful Derm, as he stated, we're doing "God's work". For real.

 

[DermViser]

I want to do GI. I already applied. This thread kinda made me feel like I should have done something else lol

Well when you're deciding amongst ENT, Ophtho, and IM, so those are as different as you can get.

 

[jdh71]

I'm so proud of you, doctor. Really. I remember when you were just a douchesnozzle with so much to learn. You're there, man. And don't shy away from leadership positions-- take that Chief of Department when it's offered.

What? Lol.

Are you mad about something bro?

 

[jdh71]

Yep. Not too long ago I was called on a consult for a rash on this 38 yo's body. She had it for about a month...really itchy. Within 30 seconds I was telling the consultant to get a lipid panel. They looked at me all confused. I said "just please do it".

Eruptive Xanthomas

I think her TGs were over 1400...could have very well saved her life...or least a bunch of morbidity.

Saved her life.

You are titrating her cholesterol meds?

 

[DermViser]

Saved her life.

You are titrating her cholesterol meds?

Not that I want to get in this tornado, but you do realize (I hope) that Dermatology treats a LOT MORE than just "rashes" correct? I realize it's easy to label everything just a rash, but people do come with very serious things: malignant melanoma, cutaneous T-cell lymphoma which can get to tumor stage and can require chemotherapeutics, TEN, Pemphigus, etc.

I can't believe you're equating titrating cholesterol medications (based on what we know now) to saving a life.

 

[DermViser]

I liked GI because 1) I still like the OR and doing procedures is rewarding to me 2) I don't think I want to be a surgeon and make a huge part of my training learning techniques (I know GI there is some aspect to this, but no where near the above fields). 3) GI procedures are small scale, you won't be in the OR on your feet all day long. 4) Really interested in the management/research in IBD, IBS, others. 5) Still lots of clinic, intellectual component to the field in terms of diagnosing, etc 6) Reimburses well and the hours are not life destroying (?)

You're kidding right? Have you actually worked a full month with a GI fellow?

Also, if you're not operating, you're not in the OR. I can do a skin punch biopsy in this room:

That doesn't mean I'm in the OR.

 

[JP2740]

You're kidding right? Have you actually worked a full month with a GI fellow?

Also, if you're not operating, you're not in the OR. I can do a skin punch biopsy in this room:
That doesn't mean I'm in the OR.

Relax it's a technicality. You can do them in the OR... I've seen them done in a VA OR. I already said I don't want to be a surgeon. Why are you offended?

I didn't even mean be in the OR. I was contrasting. GI procedures v.s. being in the OR on your feet all day long ( like you can be in ENT )

 

[DermViser]

Relax it's a technicality. You can do them in the OR... I've seen them done in a VA OR. I already said I don't want to be a surgeon. Why are you offended?

I didn't even mean be in the OR. I was contrasting.

I'm not offended. You're partly choosing a specialty based on the room you're in. Not to mention you are just plain wrong if you say that a GI fellow is not on his feet all day long.

 

[jdh71]

Not that I want to get in this tornado, but you do realize (I hope) that Dermatology treats a LOT MORE than just "rashes" correct? I realize it's easy to label everything just a rash, but people do come with very serious things: malignant melanoma, cutaneous T-cell lymphoma which can get to tumor stage and can require chemotherapeutics, TEN, Pemphigus, etc.

I can't believe you're equating titrating cholesterol medications (based on what we know now) to saving a life.

I had no idea that dermatology treat more than just rashes. Tell me more about this

<insert willy wanka meme here>